Headaches are a very common complaint amongst patients, and are a large source of both lost income and lost time. While many patients medicate with over-the-counter drugs such as ibuprofen and tylenol, the recent news reports of medical studies linking these drugs to dangerous side-effects of kidney and liver damage are sending patients in search of natural treatments.
While some natural medicines such as the herb Feverfew can often be used as a trial as a replacement for over-the-counter type headache medications, a good work-up for underlying causes is much more effective.
COMMON TYPES OF HEADACHES
Tension headaches are the most common type of headache. It is associated with pain that is usually dull or squeezing, and can be described as a general ache. The tension is usually found by having stiff, sore muscles in the upper back, shoulders, and neck muscles. Often times, the base of the back of the skull (occiput) is tender, with pressure reproducing pain.
Conventional treatment is usually limited to ibuprofen, tylenol, and other over the counter pain medications. While excellent for occasional pain, if used for any great frequency (more than twice a month), the below options are best.
Naturopathic work-up and treatments: the two most common causes are related to problems with maintaining stable blood sugar and problems with chronic muscular spasm. Treatment for the blood sugar component is typically with diet and ozone therapy. The chronic muscular spasm often does not require any special laboratory testing. It is very effectively treated in my experience with injections into the muscle, and with acupuncture.
Migraine headaches are less common than tension headaches, but often more debilitating. Patients with migraine headaches who come to me have often been diagnosed with this condition elsewhere.
The most common symptoms associated with this type of headache include nausea and sensitivity to sound or light. Some patients describe visual changes (aura) that precede the headache, while others simply wake up with the pain.
Conventional medication can be useful if a patient is responding to preventative "triptan" type drugs or low-dose beta blockers. If these are well-tolerated, they may be a good option for this debilitating pain. If a patient is not responding well to the preventative drugs and is still having more than one attack a month, the below natural treatments and naturopathic work-up should be considered.
If a patient is having a migraine attack, the best treatment in my experience, is the Modified Myer's injection as described below, with added magnesium. All IV treatments are individualised to patient case specifics. My patients have found it more potent and better at aborting the pain, compared with other natural and prescriptive agents. Relief is often immediately after the injection, and the migraine may not return.
IV Magnesium & Migraine reference below (more references at bottom of page):
Clin Neurol Neurosurg. 2019 Mar;178:31-35. doi: 10.1016/j.clineuro.2019.01.007. Epub 2019 Jan 21.
Experiences of an outpatient infusion center with intravenous magnesium therapy for status migrainosus.
Exploratory study to investigate the effectiveness of intravenous magnesium as an abortive for status migrainosus in an outpatient infusion center, and characterize the patients who benefit from the therapy.
PATIENTS & METHODS:
Retrospective analysis of 234 migraine patients who received IV magnesium as a headache abortive, at the headache clinic of University of Southern California. Additional intramuscular (IM) injections for nausea (prochlorperazine, odansetron, metoclopramide) or for refractory pain (ketorolac, dexamethasone, sumatriptan, dihydroergotamine), were administered as necessary. Immediately before and after treatment, self-reported pain levels were recorded using an 11-point numeric pain rating scale (0-10).
Our patient sample has a mean age of 44 years and was predominantly female (79%). 36 (19%) had migraine with aura. Overall, pain score decreased from 5.46±2.39 to 3.56 ± 2.75 (P < 0.001) after magnesium infusion. One hundred twenty-seven (54%) patients had clinically significant pain reduction, as defined by pain decrease ≥ 30%. One hundred and four patients (44%) received IV magnesium and did not require additional intramuscular (IM) medications for pain. In patients who did not receive additional IM medications for pain, pain score decreased from 4.76 ± 2.41 to 2.95 ± 2.70 (p < 0.001), and 61 out of 104 (59%) experienced ≥ 30% pain reduction. Patients with less severe pain tended to have a better response than patients with more severe pain, as patients with ≥30% pain reduction had a significantly lower pre-treatment pain score (p = 0.018).
For a subset of patients with status migrainosus, IV magnesium therapy results in clinically significant pain relief without the need for intramuscular pain medications. Therefore, IV magnesium may be useful as a cost-effective first-line parental therapy for status migrainosus, especially for patients who initially present with lower pain intensity.
Migraine Headache Naturopathic work-up and treatments: involve a work-up for food sensitivities and mineral stores in the body. In my experience, many patients experience significant relief after identification of food sensitivities through a blood test, and elimination of those foods is done. Rechallenging of eliminated foods can help to isolate which foods may be potentially aggravating specific symptoms. Mineral levels, of magnesium in particular, can be low. If an acute migraine attack is occurring, IV vitamin/mineral high in magnesium are often very effective in my experience at reducing pain or aborting the attack. A short treatment course of Modified Myer's injections can often be effective, in my experience, at reducing the frequency of attack as well. All IV treatments are individualised to patient case specifics.
Cluster headaches are less frequent than other forms. They are characterized by one-sided pain, usually around the eye. Occasionally symptoms of blood vessel involvement such as a runny nose may be present. Congestion and pressure can also be present. The headaches are more common in men, and may often be associated with stressful periods.
Alcohol avoidance is important in my experience in reducing the frequency of these headaches.
Naturopathic work-up and treatments: this type of headache usually does not require a conventional work-up to find an appropriate treatment plan. However, in many patients food sensitivity testing can be useful. Chemical sensitivities and food exposures are often in my experience triggers for this type of headache. In patients who experience this headache in increased frequency during periods of stress, an adrenal stress index to measure salivary cortisol at 4 times during the day may be useful. The cortisol pattern, if abnormal, may be corrected to restore normal hormone secretion. A therapy called ultraviolet blood irradiation may be useful in my experience in reducing the frequency of these attacks. Usually 6-8 treatments are necessary. In a minority of cases, the Modified Myers / IV vitamin-minerals described above may help patients in reducing the frequency of attacks. All IV treatments are individualised to patient case specifics.
Rationale for IV Vitamin / Mineral Injections:
· IV administration of nutrients can result in serum levels much higher than possible with oral administration (Okayama et al, JAMA 1987; Sydow M et al, Intensive Care Med. 1993.)
· Magnesium may promote smooth muscle relaxation in blood vessels and bronchial muscle (Iseri LT et al. Am Heart J. 1984)(Brunner EH et al. J Asthma. 1985.), that may be beneficial for migraine headache.
· IV administration of 7.5 g of vitamin C over an hour has been demonstrated to reduce serum histamine levels by 31% (Hagel AF et al. Naunyn Schmiedebergs Arch Pharmacol. 2013.) This may be beneficial for allergic conditions.
· Some nutrients may exert effects that are concentration dependent, such as anti-viral effects of vitamin C at 10-15 mg/dl (Harakeh S et al. Proc Natl Acad Sci. 1990.), only achieved through IV administration
Modified Myers’ ingredients: May contain magnesium, calcium, Vitamin C, B-complex, B6, B5. Formulation is modified to better meet patient case specifics. This may be diluted to ~35mL with sterile water and given as an IV push, or push into 100mL saline and given slower as an IV drip.
Myers’ injection safety: Generally well tolerated by most patients in our experience. Dr Alan Gaby (MD) boasts that he had no adverse reactions in approximately 15,000 treatments when administered with caution and respect (Gaby, Alan. Nutritional Medicine, 2nd Ed.) Extra caution should be taken in potassium depleting conditions and medications (e.g. taken potassium depleting medications; states of low potassium: potassium depleting diuretics, beta agonists, glucocorticoids, diarrhea, vomiting, malnourishment), as IV magnesium can potentially worsen low blood potassium levels (can increase risk of digoxin induced cardiac arrhythmias). Conditions in which magnesium may be omitted include Myasthenia gravis, urinary tract infections with elevated urinary phosphates, hyperparathyroidism. Lower nutrient doses may be used in mild to moderate renal insufficiency. The Modified Myers’ injection may cause a sensation of heat (from magnesium.) Low blood pressure and excessive heat may be associated with rapid injection, and higher dose of magnesium. Lower magnesium doses and slower injections (e.g. IV drip) may be indicated for those with lower blood pressure. Anaphylactic reactions to thiamine (B1) have been reported in the medical literature on the rare occasion. The Myers’ injection tends to be hypertonic (concentrated), thus tenderness, burning sensation at the injection site, vein irritation, phlebitis is possible. Often repositioning the needle in the vein or further diluting nutrients can help reduce or eliminate pain or irritation. Myers’ injection given as an IV drip (in 100cc of saline tends to be less hypertonic/concentrated).
Labs: Baseline bloodwork is run prior to any intravenous injection therapy, including by not limited to, kidney function (creatinine), liver enzymes, red/white blood cells, and other blood labs depending on the case. Thyroid hormone (blood TSH, T4, T3, reverse T3, TPO), adrenal (AM blood cortisol, 4 point salivary cortisol) and/or other lab testing may be recommended as per case history and physical exam findings, to better help elucidate attributing factors to chief concerns and presenting symptoms.
Ozone therapy safety (major autohemotherapy): A survey done in Germany of close to 5 million ozone treatments showed an accident rate of 7 serious incidents, all associated with direct IV injection of the gas (not done in our clinic). There is a slight possibility of allergy to heparin, though this is a commonly used blood thinner. Some patients do not like the site of their own blood, but they quickly become accustomed to this.
In our experience, the most frequently seen (but still rare) side effect is dizziness/vasovagal/fainting reaction due not at all to the volume of the blood, but rather the needle experience as well as seeing the blood. Possible but extremely rare complications may include soft tissue infection (as with any injection / blood draw), or vein inflammation and clots.
One recent case study has been published on ozone therapy where a single patient with kidney failure had high blood potassium and subsequent arrhythmia. The authors had concluded that the ozone therapy (which looked to be done 9 days in a row) was to blame, but this is not at all clear. The authors did not think that red cell breakdown was responsible for the high blood potassium, but that is the only mechanism that would make sense if the ozone was done daily. Theoretically low grade red cell breakdown would release potassium, and if the treatment is overdone and the kidneys can not excrete this could accumulate.
Photoluminescence therapy (ultraviolet blood irradiation) was used extensively in the 30's to 40's before the advent of antibiotics and the vaccine for polio. It has an extensive safety and efficacy record. For a great summary of this treatment, buy the book "Into the Light" at www.drdouglass.com. An online article also available is “The Cure that time forgot” which summarizes much of the published experience. Potential side effects of ultraviolet blood irradiation are similar to those mentioned above for ozone therapy/major autohemotherapy.
In our clinical experience, we have treated a variety of conditions in which patients have received IV treatments as art of an individualised health plan. Our IV treatments are individualised to patient case specifics.
References: Myers’, Intravenous vitamin/mineral injections
Gaby AR. 2002. Intravenous nutrient therapy: the "Myers' cocktail". Altern Med Rev. 2002 Oct;7(5):389-403.
Ali A, Njike VY, Northrup V, Sabina AB, Williams AL, Liberti LS, Perlman AI, Adelson H, Katz DL. 2009. Intravenous micronutrient therapy (Myers' Cocktail) for fibromyalgia: a placebo-controlled pilot study. J Altern Complement Med. 2009 Mar;15(3):247-57.
Okayama H, Aikawa T, Okayama M, Sasaki H, Mue S, Takishima T. 1987. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987 Feb 27;257(8):1076-8.
Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. 2000. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev. 2000;(2):CD001490.
Sydow M, Crozier TA, Zielmann S, Radke J, Burchardi H. 1993. High-dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus. Intensive Care Med. 1993;19(8):467-71.
Harakeh S, Jariwalla RJ, Pauling L. 1990. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells. Proc Natl Acad Sci U S A. 1990 Sep;87(18):7245-9.
Harakeh S1, Niedzwiecki A, Jariwalla RJ. 1994. Mechanistic aspects of ascorbate inhibition of human immunodeficiency virus. Chem Biol Interact. 1994 Jun;91(2-3):207-15.
Hagel AF, Layritz CM, Hagel WH, Hagel HJ, Hagel E, Dauth W, Kressel J, Regnet T, Rosenberg A, Neurath MF, Molderings GJ, Raithel M. 2013. Intravenous infusion of ascorbic acid decreases serum histamine concentrations in patients with allergic and non-allergic diseases. Naunyn Schmiedebergs Arch Pharmacol. 2013 Sep;386(9):789-93.
Iseri LT, French JH. 1984. Magnesium: nature's physiologic calcium blocker. Am Heart J. 1984 Jul;108(1):188-93.
Brunner EH, Delabroise AM, Haddad ZH. 1985. Effect of parenteral magnesium on pulmonary function, plasma cAMP, and histamine in bronchial asthma. J Asthma. 1985;22(1):3-11.
Sharma SK, Bhargava A, Pande JN. 1994. Effect of parenteral magnesium sulfate on pulmonary functions in bronchial asthma. J Asthma. 1994;31(2):109-15.
References: Ozone and Diabetes
Bocci V, Zanardi I, Huijberts MS, Travagli V. 2011. Diabetes and chronic oxidative stress. A perspective based on the possible usefulness of ozone therapy. Diabetes Metab Syndr. 2011 Jan-Mar;5(1):45-9.
Bocci V, Zanardi I1, Huijberts MS, Travagli V. 2014. It is time to integrate conventional therapy by ozone therapy in type-2 diabetes patients. Ann Transl Med. 2014 Dec;2(12):117.
Bocci V, Zanardi I, Huijberts MS, Travagli V4. 2014. Diabetes Metab Syndr. 2014 An integrated medical treatment for type-2 diabetes. Jan-Mar;8(1):57-61.
de Monte A, van der Zee H, Bocci V. 2005. Major ozonated autohemotherapy in chronic limb ischemia with ulcerations. J Altern Complement Med. 2005 Apr;11(2):363-7.
Braidy N, Izadi M, Sureda A, Jonaidi-Jafari N, Banki A, Nabavi SF, Nabavi SM5. 2018. Therapeutic relevance of ozone therapy in degenerative diseases: Focus on diabetes and spinal pain. J Cell Physiol. 2018 Apr;233(4):2705-2714.
Bocci V, Zanardia I, Valacchi G, Borrelli E, Travagli V. 2015. Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases. Cardiovasc Hematol Disord Drug Targets. 2015;15(2):127-38.
Giunta R, Coppola A, Luongo C, Sammartino A, Guastafierro S, Grassia A, Giunta L, Mascolo L, Tirelli A, Coppola L. 2001. Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Ann Hematol. 2001 Dec;80(12):745-8.
Valacchi G, Bocci V. 2000. Studies on the biological effects of ozone: 11. Release of factors from human endothelial cells. Mediators Inflamm. 2000;9(6):271-6.
Inal M, Dokumacioglu A, Özcelik E, Ucar O. 2011. The effects of ozone therapy and coenzyme Q₁₀ combination on oxidative stress markers in healthy subjects. Ir J Med Sci. 2011 Sep;180(3):703-7.
Wu XN, Zhang T, Wang J, Liu XY, Li ZS, Xiang W, Du WQ, Yang HJ, Xiong TG, Deng WT, Peng KR, Pan SY. 2016. Magnetic resonance diffusion tensor imaging following major ozonated autohemotherapy for treatment of acute cerebral infarction. Neural Regen Res. 2016 Jul;11(7):1115-21.
Smith NL, Wilson AL, Gandhi J, Vatsia S, Khan SA. 2017. Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Med Gas Res. 2017 Oct 17;7(3):212-219.
Molinari F, Simonetti V, Franzini M, Pandolfi S, Vaiano F, Valdenassi L, Liboni W. 2014. Ozone autohemotherapy induces long-term cerebral metabolic changes in multiple sclerosis patients. Int J Immunopathol Pharmacol. 2014 Jul-Sep;27(3):379-89.
References: Ultraviolet Blood Irradiation
Hamblin MR. 2017. Ultraviolet Irradiation of Blood: "The Cure That Time Forgot"? Adv Exp Med Biol. 2017;996:295-309.
Wu X, Hu X, Hamblin MR. 2016. Ultraviolet blood irradiation: Is it time to remember "the cure that time forgot"? J Photochem Photobiol B. 2016 Apr;157:89-96.
Kuenstner JT, Mukherjee S, Weg S, Landry T, Petrie T. 2015. The treatment of infectious disease with a medical device: results of a clinical trial of ultraviolet blood irradiation (UVBI) in patients with hepatitis C infection. Int J Infect Dis. 2015 Aug;37:58-63.
References: Acupuncture for Headaches, Pain
Mayrink WC1, Garcia JBS2, Dos Santos AM2, Nunes JKVRS3, Mendonça THN2.2018. 2018. Effectiveness of Acupuncture as Auxiliary Treatment for Chronic Headache. J Acupunct Meridian Stud. 2018 Oct;11(5):296-302.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin BC, Vickers A, White AR. 2016. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016 Apr 19;4:CD007587.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. 2016. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016 Jun 28;(6):CD001218.
Nielsen A. 2017. Acupuncture for the Prevention of Tension-Type Headache (2016). Explore (NY). 2017 May - Jun;13(3):228-231.
Yin C, Buchheit TE, Park JJ. 2017. Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol. 2017 Oct;30(5):583-592.
Lin YC, Wan L, Jamison RN. 2017. Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence. Anesth Analg. 2017 Dec;125(6):2081-2093.